Inside 2020: The Year of the Nurse and Midwife · International Year of the Nurse and Midwife by...

A companion House Memorial 28 was introduced in the NM House of Representatives by Representatives Joanne J. Ferrary, Elizabeth "Liz" Thomson, Debra M. Sariñana, Deborah A. Armstrong and Karen C. Bash

VOLUME 65 • NUMBER 2 APRIL 2020

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On January 30, 2020 The New Mexico Senate declared 2020 as the Year of the Nurse and Midwife in the State of New Mexico to mirror the international effort. Barbara Dossey, PhD, RN, AHN-BC, FAAN, HWNC-BC, represented the New Mexico Nurses Association and New Mexico nurses in attendance at Capitol Challenge on the Senate floor. Senator Liz Stephanics read Senate Memorial 22 recognizing the impact of nurses and midwives on the health care of all New Mexicans. The Senate Memorial was cosponsored in the 54th New Mexico Legislature Second Session 2020 by New Mexico Senators Elizabeth "Liz" Stefanics, Gay G. Keran, Gerald Ortiz Pino, Mary Kay Papen, Shannon D. Pinto, and Mimi Stewart.

Barbie & Sen. Stefanics SM#22IYNM Jan 30 2020 Barbie (1) Memorial SM #22 IYNM 1.30.20

2020: The Year of the Nurse and Midwife

Student nurse leaders from CNM, Luna, NMSU Carlsbad, Northern New Mexico College, San Juan College, Santa Fe Community College, UNM Taos, and UNM helped to kick off the

Year of the Nurse and Midwife in New Mexico during Capitol Challenge. The celebration begins with the remembrance that May 12, 2020 will be the 200th birth anniversary of

Florence Nightingale!!!

• The New Mexico Nurse April, May, June 2020

NMNA Board, Committee Chairs and StaffPresident: Gloria Doherty, PhDc, MSN, Adult Health Nurse Specialist, ACNP-BC

Vice President: Michael Shannon, MSN, [email protected]

Treasurer: Barbara Salas CNP

Secretary: Ruth Burkhart, DNP, MSN, RN

Directors:Keith Carlson, RN, BSN, [email protected]

Rachel Frija DNPc, SN, RN-BC

Wendy Hewlett BSN, MSN, MHA, RN

Lisa Leiding, MSN, RN

Judy Liesveld BSN, MS, PhD

Camille Adair, RN

Lisa Marie Turk MSN, [email protected]

Committees:Government Relations Committee Co-ChairsLisa Leiding RN, MSN, Razvan Preda DNP and Christine De Lucas , DNP, MPH, RN

Guest Editor Deborah Walker, MSN, RN

NMNA Website: www.nmna.orgOffice Mailing Address: P.O. Box 418, Santa Fe, NM 87504

Office Phone: 505-471-3324

Executive Director: Deborah Walker, MSN, RN3101 Old Pecos Trail #509 Santa Fe, NM 87505Office: 505-471-3324 Cell: 505-660-3890

Continuing Education Coordinator:Suzanne Canfield, MBA, BSN, [email protected] 505-690-6975

Peer Reviewers:Phyllis Chester, DNP, MS, BC-FNP, RN Becky Gonzales, MSN, RN, BC/BSSusan Jurica, MSN, BSN, RN Cynthia Nuttall, PhD, RN, NE-BCClaudia Phillips, MSN-Ed, RNBarbara Shortt, BSN, RN

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Gloria Doherty PhDc, MSN, ACNP-BC

Welcome to 2020 officially designated as the International Year of the Nurse and Midwife by the World Health Organization. The American Nurses Association has also deemed 2020 as the Year of the Nurse!! What a spectacular way to start a new decade!!!!

First, I would like to thank you for your support and your faith in me as President for a second and final term. It is my honor and privilege to serve. I hope in this term, particularly in this Year of the Nurse, ample opportunity is provided for nurses and advanced practice nurses to continue to break down barriers. Successfully caring for the populations we serve to the fullest extent of our education, training, and licensure is our goal, further, we are engaging more RNs and LPNs as we work to achieve these opportunities.

As you know, I have written and professionally presented on advocacy. I am a true believer that advocacy is the key to successful, high quality health care in our state. As nurses, this is a natural role we each play. Advocacy is in 80% of the statements from the American Nurses Association Code of Ethics. We advocate for our patients every day at the bedside and a wide arena of health care settings. Many of us advocate at institutional levels. Others volunteer or sit on boards. Still others of us advocate at local and state administrative levels. Some of us advocate on national policy and institutional levels. How amazing to think of all of us contributing to the greater good!!! This being the Year of the Nurse, get involved in an area that may be outside of your comfort zone; reach outside that zone and fight for something about which you are passionate, ultimately increasing awareness to influence decision making.

There are over four million nurses in the United States. We continue to be the most trusted profession with respect to honesty and ethics according the Gallup Poll. The public continues to recognize the importance we have in delivering health care. It is our duty to ensure we continue to be able to provide that care and even improve it. As you may well remember, in 2010, the Institute of Medicine published the landmark report on The future of nursing: Leading change, advancing health. That report had many recommendations. Included in those recommendations was the idea of serving on boards, and working collaboratively with other disciplines and legislators to not only implement health care policies, but to create health policy. We touch every person from the onset of life to dying with dignity. We care not only for patients, but also their families. Who better than to solve the imperfections of health care? We experience every bottle neck, every delay in care; we see where changes need to occur; where access needs to be improved. We understand the needs of vulnerable populations and have the creativity necessary to achieve improved outcomes. While 2020 is the Year of Nurse, we serve every day. Together, let us make 2020 the year of shine. The year where we are sought to solve problems, create policy, and improve all levels of care for all those we serve, one person at a time, one policy at a time.

We must also learn how to recognize each other for the phenomenal work we do. I implore you to navigate ANA.org and any other professional organization you may belong to (nursing or otherwise) to find ways to recognize your colleagues. We are an amazing bunch! We quietly serve, we quietly make a difference. Let this Year of the Nurse be one where we shout from the rooftops about how awesome we are. Let legislators and policy makers of all levels know the amazing work each and every one of us do in our profession and how we can change the delivery of care for the better. We each have something to contribute.

I end with the plea for you to show your shine. It is THE Year of the Nurse. Let us make it a memorable one. Let’s look back at the end of the year and have something to be proud about as a profession. Serving as your President, I hope you reach out to NMNA with ideas, concerns, opportunities and struggles. Together we are a force! Together we can accomplish more. We are the largest sector of health care delivery; we are the experts; we deliver the care! Let’s make sure we do it better and creatively and collaboratively to improve our care and the care of others. The power we can achieve together remains largely untapped. Let’s do tap it together during 2020!!

Welcome 2020

From The NMNA President

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April, May, June 2020 The New Mexico Nurse •

Sheena M. Ferguson, MSN, RN, Doctoral Student, ANA-I [email protected]

I was reflecting the other day on a presentation that I attended two years ago at the Western Institute of Nursing (aka WIN). WIN is one of four regional nursing knowledge organizations in the United States whose members include researchers, clinicians, educators, students, academic institutions, as well as our health care organizations. WIN strives to improve the health of the public through visionary leadership in nursing education, research, and practice as nurses develop and study new and emerging nursing knowledge. Again, we see that critical professional triad of education, research and practice.

The presentation that I attended was standing room only, and it generated a lot of buzz. The topic? As far as educating nurses about the cost of health care and our role as nurses in the cost of health care, academia deserves a grade of “F.” The entire audience was astonished, but you couldn’t argue the truth. We fail in our education of nurses about health care dollars. And yet, the best ideas for how health care can thrive and truly be a system of health care can come from the only 24/7/365 professional. However, when we are not given the tools to understand health care system costs, the finance behind what we do, it is very hard to find solutions that work.

What nurses do know is that the cost for their patient’s health care is skyrocketing as well as their own health care insurance for themselves and/or their families. One of the best examples is patients with diabetes not being able to afford a basic medication like insulin. That just does not make sense, right? Patients get sicker and have increased complications that add to the cost of their care without their medications, and we all pay for it. And as we have discussed before, our health care costs in the United States are significantly higher than other industrialized nations and the quality is half as good. Think about that: twice as costly and half as effective (more about this in another issue).

So, we as nurses do not receive the education that we need on health care expense, but as a group we don’t look for it either. We really are not comfortable talking about the money. One of the major discussions that is occurring in the United States today is health care staffing and how teams work together to provide better care. In this issue, we will review a common metric of nursing productivity, the Hours of Care per Patient Day (HOCPPD). This is a nationally standardized definition that nurse researchers have studied to understand the impact of staffing on patient outcomes and health care quality. HOCPPD is a main feature of the National Database of Nursing Quality Indicators (NDNQI). It allows us to compare the hospital we work for to other hospitals across the U.S. and to look at trends in patient care.

To calculate HOCPPD, you need to know numbers of staff and numbers of patients. There are two primary calculations, one is for Nursing Hours of Care (Nsg HOC) which includes RN’s, LPN’s, Nursing Techs or Aides, and some organizations add-in patient observation attendants or “sitters” (which they should not). Only the direct care givers on the unit should be counted for the Nursing Hours of Care (you have a patient care assignment). The second is RN Hours of Care (RN HOC) which only uses RN numbers, so Nursing HOC is higher than RN HOC. (When you have support staff in your areas.) RN HOC is listed first in the table below.

Here are some examples:

Unit Bed Size

Number RN’s

Charge Nurse

Techs RN HOC Nsg HOC

Days 24 6 1 3 3 + .5 = 3.5 3.5 + 1.5=5.0

Nocs 24 6 1 2 3 + .5 = 3.5 3.5 + 1.0=4.5

Total 7.0 9.5

Professional Governance: Why Talk About Hours of Care? (Part IlI)A staff member on each shift can only contribute 12 hours to the calculation. On the

Day Shift example above, an RN will have four patients, so each patient will on average receive three hours of care from the RN. The Tech on days will have eight patients (24 divided by three techs) so each patient gets 1½ hours from the Tech. The charge nurse contributes 30 minutes to the HOC, since their 12 hours is distributed among 24 patients. You can see that a “free” charge does not add significantly to the HOC. You can look at your NDNQI numbers, or whatever benchmark metric you use, or Google HOC and see how your unit compares to other organizations. But also look at the costs, each RN adds $66,000 X 4.2 (the 24/7 calculation one RN on a shift requires 4.2 RNs to cover 24 hours per day, seven days per week) or $277,200 per year for each additional RN to the costs of care. Replicate that among the number of units in your organization and we can see why we need enough but need to avoid over-staffing. HOC does not include the staff covering the “desk,” not the educators, not the director/manager of the unit.

Here is a cheat sheet for RN HOCPPD:

RN to PT 2 RN: 1 PT

1 RN:1 PT

1 RN:2 PT

1 RN:3 PT

1 RN:4 PT

1 RN:5 PT

1 RN:6 PT

1 RN:7 PT

1 RN:8 PT

12 hr Shift

24 12 6 4 3 2.4 2 1.7 1.5

24 hr Day

48 24 12 8 6 4.8 4 3.4 3

ADD Charge RN

So, a nurse who has six patients is able to provide two hours of care to each patient on their shift. The Charge Nurse is determined by taking the number of patients and dividing that by 12 hours, so on a 24-bed unit, the charge nurse per shift adds 0.5 hours to this total. So, a patient on a 24-bed unit with a “free” charge nurse, and an RN with six patients provides the patient with 2.5 hours of care on that shift, or five hours of RN care per patient day. On smaller units, less than 24 beds, the “free” charge has more time per patient, conversely units that are bigger than 24-beds, the “free” charge nurse has less time per patient, and it decreases HOC. HOCPPD is required to be reported and posted daily in a growing number of states. This permits transparency to the public. One state, California, has mandated HOCPPD due to required staffing levels in hospitals. Considering ALL types of units across the country, the average RN HOC is around 10.7, as only the sickest patients stay in hospitals and as the Nursing HOC is decreasing.

Hospital CFO’s (Chief Financial Officers) may also use an Hours of Care number, but it is not the same thing as we are discussing in this article.…it includes all staff (direct and indirect) in the number, including training and education costs. Hours of care per patient day also gets a bad rap because it doesn’t interpret when we have a patient who needs more hours of care, you have a patient with increased needs who is being transferred to the ICU. It isn’t predictive for patient changes; no method right now does that for planning care. Currently, we don’t have a system that captures that changing patient condition need. Our next issue will discuss more about that opportunity and the impact of staffing on patient safety.

Aiken, L. H., Clarke, S., Sloane, D., Sochalski, J. & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288 (16): 1987–93.

Spetz, J., Donaldson, N., & Brown, D. (2008). How many nurses per patient? Measurements of nurse staffing in health services research. HSR: Health Services Research 43:5, Part I (October 2008)

http://www.UNMnursing.com


Dr. Karen L. Brooks, Esq., EdD, MSN RN

The importance of discharge planning is the focus for this liability issues column. There are liability concerns associated with failure to provide clear and understandable discharge instructions to patients and clients. These concerns will be addressed in this column along with a hypothetical that underscores how a discharge plan might go awry for an emergency department patient and the emergency nurse who is providing the discharge instructions.

Start Your Discharge Planning EarlyBefore discussing the legal ramifications surrounding

discharge planning, there should also be mention of other reasons that support a timely and thoughtful discharge planning process for the patient. Providing a seamless transition from one care environment to another demands that discharge plans be clearly articulated between and among those discharging the patient and those to whom the patient is being discharged; as example, when a patient is being discharged from the hospital and being admitted to a rehabilitation facility. When the patient/client is

transitioning from hospital or clinic or office to home or another type of health care agency, the discharge plan is integral. This is for continuity and correct, versus incorrect, delivery of care. Further, the nurse who is discharging the patient is bound by advocacy obligations and patient teaching responsibilities that are written into state nurse practice acts. The value or cost saving aspect of timely and correct discharge planning also needs to be mentioned. Preventing readmissions into the hospital or reducing need for follow-up is cost beneficial for both the patient and the health care agency. Reimbursement can be tied, and may be denied, depending on whether or not a patient needs to be readmitted to a health care facility within a certain timeframe, under the same diagnosis, for which he/she was previously discharged.

To now focus the discussion on liability issues that can be associated with nursing failure to properly engage in a thoughtful and timely discharge process, a hypothetical will be provided.

Admittedly, nurses working in healthcare environments often have limited time with the patient given the rapidity of care delivery and limited length of stay in the hospital or care environment. Limited time with the patient or being busy or rushed, however, are not adequate defenses for the nurse’s failure to properly prepare a patient for discharge. For this reason, a thoughtful discharge planning process needs to commence as soon as the patient comes into the health care environment and the plan of care is developed. What are the patient needs? Where will the patient go after leaving the facility? What are potential treatments and medications that might be ordered? Will some type of durable medical equipment be needed for use after discharge? And, of course, the correct plan of care must be associated with the correct patient just as the right medication must be given, in proper dosage, via the correct route, at the right time and to the right patient.

Malcolm came to the emergency department in the early morning hours as he was abruptly awakened by right sided flank pain. He recognized this pain as being more than likely due to a kidney stone. Malcolm had a history of stones although the pain, this time, seemed much more intense and so Malcolm thought he should be seen by an emergency physician. Malcolm was properly evaluated by the emergency physician and the treatment plan, discussed and documented by the physician with Malcolm, was to discharge Malcolm to his home with specific instructions for forcing fluids and pain medication until the stone passed on its own. The instructions and the plan were simple enough and straightforward. Malcolm was familiar with the care routine. When the nurse hurriedly came into Malcolm’s room with the discharge documents and prescription information, she handed the written information to Malcolm, saying very few words beyond, “here is your discharge information and you are free to go.” Fortunately, Malcolm glanced at his paperwork and saw the diagnosis of gastroenteritis and his name on the documents. He summoned the nurse back into

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his cubicle and pointed out the errors. The nurse then returned with the proper paperwork, still offering very little information related to the medications that were ordered and the care instructions. This nurse has failed in her obligations to properly prepare the patient, Malcolm, for discharge. Being rushed or busy or simply dismissive in no way mitigates the nurse’s substandard conduct in this hypothetical. Malcolm, being his own best advocate, was able to prevent a potentially serious outcome. Had there been a serious, even fatal, outcome for Malcolm associated with this emergency admission, the nurse’s conduct could potentially be adjudicated as the proximate and primary cause of any and all related injuries and complications. In this unfortunate scenario, the nurse could be found liable, be responsible for paying significant monetary damages to Malcolm and could face nursing license sanction, up to and including license revocation by the state board of nursing.

The nurse, who is properly following standard of care and state nurse practice act obligations, needed to review the discharge plan with Malcolm including the expectations for forcing fluids, what that exactly meant, and also should have discussed the associated medications and any need for follow-up as ordered by the physician. In addition, the nurse should have also verified Malcolm’s understanding of what she (the nurse) was discussing by having Malcolm repeat back what he understood to be the discharge plan and instructions. This teaching dialogue should have been documented in Malcom’s record.

The nurse also needs to have her own professional liability coverage.

Dr. Karen L. Brooks, Esq., EdD, MSN RN is the Graduate Nursing Faculty Lead (Remote: Santa Fe, New Mexico) Global Campus for Southern New Hampshire University and provides this column as a member of the New Mexico Nurses Association and ANA.

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We are looking for experienced nurses to

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Suzanne J. Canfield, MBA, BSN, RN

A Learning Outcome is the primary reason we provide education. What will the nurse participants learn by the end of the activity that they intend to use in their practice settings, and how will we know? Often learning outcomes are confused with goals and objectives, but they are very different. In educational activities, the presenter develops goals and objectives for what is being provided to the audience. It is the outline for what is planned to be presented. A measurable learning outcome, on the other hand, is the end result of the activity from the learners’ perspectives.

The planners of an activity can identify learning outcomes based upon the gap analysis, however, learners should also identify their own personal learning outcomes. As described in a prior New Mexico Nurse article, adult learning principles play a substantial role in an educational activity. A topic must be meaningful and relevant to learners to create internal motivations to learn. If a personal learning outcome is identified by each learner, he/she will actively pursue those outcomes.

Evaluating whether learning outcomes were met is the next step where activity planners can know whether the activity closed the gap between the current state and the desired state. To this end, the learning outcome must be stated in measurable terms. Knowledge and skills can be evaluated by the end of the activity; i.e., a nurse can pass a post-test, demonstrate a new skill, participate in role-playing or case analysis or contribute to discussions among other methods. Learning outcomes may also include evaluations of practice which can only be done in actual practice settings after the activity. This means that a learning outcome cannot be stated to imply what a nurse “will do or know in the future,” but must be stated in terms of what can be measured at the time of the activity or observed in the practice setting at a later time. Observing IV practices, sterile dressing changes, other types of patient interactions and quality studies are examples of evaluating learning outcomes in practice.

NURSING CONTINUING PROFESSIONAL DEVELOPMENTPart 4: Learning Outcomes and Evaluations

The following infographic provides a review of the educational activity flow from the identified issue through evaluation of the learning outcome.

Finally, those who planned the activity should review

data gathered from the participants, presenters and other stakeholders. Integrating this data will provide evidence whether the gap was closed, whether the activity and strategies were appropriate for the target

audience and whether the activity should be altered in any way before it is presented in the future. This is called a summative evaluation and is an essential part of a nursing continuing professional development activity

Note: Suzanne Canfield is the Nurse Peer Review Leader for the New Mexico Nurses Association

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Cara Cook, MS, RN, AHN-BC, Shanda L. Demorest, DNP, RN-BC, PHN and

Beth Schenk, PhD, MHI, RN-BC, FAAN

There is increasing interest and engagement among the nursing community around environmental matters that influence human health, such as climate change. Nurses are trusted health professionals and make up nearly 40% of the healthcare workforce, serving as catalysts of change in their institutions and practice settings.

To activate nurses, the Alliance of Nurses for Healthy Environments (ANHE) and Health Care Without Harm (HCWH), launched the Nurses Climate Challenge (the Challenge) in May 2018. The Nurses Climate Challenge is a national campaign to educate health professionals on climate and health, with nurses leading the education. The Challenge started with the original goal to educate 5,000 health professionals and was quickly surpassed in less than a year due to the combined efforts of Nurses Climate Champions around the world.

The response to the Nurses Climate Challenge has been robust. There are over 1,000 nurse climate champions from nearly all 50 states, with over 13,000 health professionals educated since the launch. In addition, nurses from 19 countries outside the United States are registered as Nurse Climate Champions.

Nurses Climate Challenge: Educating 50,000 Health Professionals by 2022

However, there are nearly four million nurses and 18 million workers in the healthcare sector in the US alone; therefore there is an opportunity to exponentially scale the impact of the Challenge. To do this, we are aiming to educate 50,000 health professionals by 2022.

The Nurses Climate Challenge offers a comprehensive toolkit with all the resources nurses need to educate colleagues on climate and health and engage in climate-smart practices in health settings and at home. Nurses using the Challenge resources are highlighted through profiles (https://nursescl imatechallenge.org /champion-profi les) published on the Challenge website, shared in newsletters, and posted on social media to showcase the work being done and to inspire others to join.

The Challenge also calls on nurses to be advocates for climate and health. Leading within a nursing organization, health institution, or academic center to spearhead initiatives to address climate change is an example of how nurses can move health professionals from education to action. The Challenge resources include a guide to taking action within workplace and home settings and provide other points to get started.

As a nurse, you can also educate policymakers and the public about the connection between climate and health and how to take action by writing a letter to the editor in a local newspaper, meeting with elected

officials, or talking with patients, friends and family members, and/or your community about the health impacts of climate change. The Challenge website includes sample talking points and template letter to the editors in the resources section.

Furthermore, the CHANT: Climate, Health, and Nursing Tool 2020 is now available. CHANT is 10-minute voluntary survey asking respondents about awareness, motivation, and behaviors related to climate and health. Nurses and other health professions are encouraged to take the survey every year. Access CHANT here: http://bit.ly/30riTR9.

Learn more and join the Nurses Climate Challenge by visiting nursesclimatechallenge.org.

Additionally, contact Health Nurse, Healthy New Mexico at NMNA at (505) 471-3324 to learn about the special interest group in NM.

Note: Beth Schenk, PhD, MHI, RN-BC, FAAN is a Nurse Scientist and Assistant Research Professor and serves as an Assistant Professor at Washington State University College of Nursing; Cara Cook, MS, RN, AHN-BC is the Climate Change Program Coordinator for the Alliance of Nurses for Healthy Environments; and Shanda L. Demorest, DNP, RN-BC, PHN is the Member Engagement Manager for Practice Greenhealth.

HEALTHY NEW MEXICO

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How to Incorporate Micro-Restorative Practices for Nurses at Work

Holly E. Carpenter, RN, BSN

Reprinted with permission from ANA Enterprise’s Healthy Nurse, Healthy Nation™

Learn how nurses benefit from mini resilience-building exercises throughout the workday.

Many nurses place themselves last on their list of priorities during their shifts. They forget to fuel themselves with healthy snacks and water, or take a bathroom break, or stop and catch their breath.

Strong evidence links job stress, safety, and health within nursing populations. Some factors that cause job stress are inevitable — there’s not much you can do about complex patient conditions. But using micro-restorative practices throughout your shift can lower nursing-related stress and improve well-being.

What Are Micro-Restorative Practices?Micro-restorative practices are small, short exercises

designed to be used throughout the workday. The goal of these activities is authentic presence. They help you learn to acknowledge when you need to pause — and then, to choose the best technique to help yourself in that moment.

The first step: Learn to uncover what your body and mind need in a stressful or chaotic moment. This step involves emotional intelligence and self-awareness. Other methods to learn what your mind/body need

and relieve stress that only take a few moments include:

• Mindfulness• Showing self-compassion• Breath awareness• Mind/body techniques, like a body scan

For example: A body scan only takes a few quiet moments, but it can help you learn what you’re feeling and how you can relieve areas of tension or pain. Follow these steps to complete a body scan:

1 Close your eyes. Center yourself. Anchor yourself to the present moment.

2 Think about the boundaries of your body and find your breath. Follow your breath for a minute or two.

3 Start with your head. Notice the temperature of your skin. Think about any tension you feel in your head or neck.

4 Move down through your body, taking note of tightness, pain, or soreness. Send your breath to places that need attention.

5 Think about the spaces between your fingers. Is your back straight? Your neck forward?

6 Imagine a loved one’s hands holding you up so you can lean back. In this moment, you don’t have to care for anyone but yourself. Trust.

7 Once you’ve moved all the way down to your feet, ask yourself: How am I feeling? What do I need?

How to Use Micro-Restorative PracticesAfter you identify the area of your mind/body that

needs attention, you can use an exercise or tactic to improve the area of concern. For example: If during the body scan you notice tension in your back, take two minutes to stretch the back muscles.

“Micro-restorative practices offer an intentional pause and check-in to become more aware of your mental, emotional, and physical state,” said Pamela Mulligan, BSN, RN, RYT 500, of Replenish Mind Body Spirit LLC. “When we can acknowledge when our emotional state is in chaos, we can find the tools to skillfully navigate it.”

Pamela works with hospitals and nursing staff to create personalized, gentle approaches that encourage mind-body awareness, self-care, self-compassion, and resilience. She worked with Cathy Alvarez, MA, RN, CNML, HNB-BC, of Yale New Haven Hospital to bring the program to nurses.

Micro-Restorative Practices at Yale New Haven Hospital

“Each individual knows what they need to be healthy and well,” said Cathy. “But they tend to give to others before giving to themselves. We needed to change the conversation about how we care for ourselves.”

Together, Pamela and Cathy brought micro-restorative practices to Yale New Haven. The first step was leadership buy-in. At Yale New Haven, this made sense because of safety and quality’s direct tie to nurse engagement and satisfaction.

Next was nursing buy-in. The program was personalized to what staff say they need. There was no micro-managing and no staff requirements. Nursing staff provided feedback on common barriers to self-care, so Pamela and Cathy could work with leadership to remove those barriers.

Finally, Pamela and Cathy focused on coaching and education. Teaching staff how and when to use micro-restorative practices gave them the tools they needed for the future. From there, it was up to staff to decide when, if, and how those practices are used throughout the workday.

The key, Pamela said, is sustainability. With the program in place, nurses experience a deeper connection to self and each other at work. It’s a culture shift with an emphasis on compassionate connection, self-care, and resilience.

Results were noticeable. Engagement scores increased by 14.2% in one month, and disengagement scores dropped. Baseline health scores improved by 4%. Contentment with work increased.

But most of all, the nurses felt heard.Does your hospital encourage micro-restorative

practices for nursing self-care? What kind of benefits have you or your coworkers witnessed? Tell us on Facebook.

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Acupuncture and Aromatherapy for Stress Relief at Work

Holly E. Carpenter, RN, BSN

Reprinted with permission from ANA Enterprise’s Healthy Nurse, Healthy Nation™

Anxiety at work? Eileen Carino, Clinical Director at Griffin Hospital, recommends acupuncture and aromatherapy.

How can we do more to take care of ourselves in the workplace?

That’s the question we continue to ask as we put our patients first (and ourselves last) day in and day out. There’s only so much time in the shift, yet so much to do. It’s not unusual to find yourself skipping the snack your stomach is growling for, or the bathroom break your bladder needs.

A Healthy Nurse, Healthy Nation’s HealthyNurse® survey found that over half of nurses surveyed often had to work through breaks, arrive early, or leave late to get their work completed. As we all know, you can’t take care of patients if you don’t first take care of yourself. That’s why micro moments for self-care in the workplace are more important than ever.

Acupuncture and aromatherapy are two easy and impactful ways to add stress relief to your shift. Eileen Carino, RN-BC, BS, MA, ADS, is the Clinical Director of the Inpatient Behavioral Health Unit at Griffin Hospital, a Planetree Hospital in Derby, Connecticut. She uses both aromatherapy and ear acupuncture in her unit

for patients and staff, and has conducted studies that prove their effectiveness.

Noninvasive Ear AcupunctureAuriculotherapy, or ear acupuncture, looks at the

ear as a microsystem of the entire body. Acupuncture needles or small magnetic beads (whichever patients choose) are placed on certain meridians on both ears to stimulate healing. The needles remain in the ear for 30 minutes and can have an immediate healing effect on the body and mind. If beads are chosen, the patients are instructed to massage the beads two to three times per day to stimulate the meridians promoting relaxation, healing, and stress reduction.

Eileen uses the National Acupuncture Detoxification Association (NADA) protocol known to be helpful in reducing symptoms of withdrawal from drugs and alcohol, decreasing anxiety and stress, and well as diminishing symptoms of PTSD. Patients and staff who receive auriculotherapy both report a decrease in levels of stress and anxiety, as well as a greater sense of well-being.

Recently, Eileen studied patients’ response to auriculotherapy in the inpatient behavioral health unit. Anxiety and well-being levels were measured pre- and post-treatment based on a scale of 0 to 8. The patient’s perceived anxiety levels dropped from 5.9 to 3 after the treatment. Sense of well-being rose from 5.5 to 7.5.

“You can tell the difference on the unit when patients receive auriculotherapy. The atmosphere changes – it is calmer,” said Eileen. “Patients and staff love it, and staff will frequently request a treatment.”

Aromatherapy in Nursing UnitsSomething as simple as the essential oils on the

nursing unit can help lower stress levels, too. Lavender, for instance, has long been used as a remedy for stress, anxiety, and sleeping problems. Bergamot is another essential oil with a reputation for its soothing effects.

In one study, the use of lavender and rosemary essential oil sachets reduced anxiety and pulse rates among test-taking nursing students. Other studies show that lavender essential oils can improve sleep quality and help treat mild insomnia.

As a certified aromatherapist, Eileen uses lavender, bergamot, and other essential oils for both patients and staff. She offers an individualized approach for patients as a complementary add-on service, so they get the essential oil best suited for their health needs. Many patients use them to sleep better while staying at the hospital.

Staff love aromatherapy, too. Eileen puts a couple of drops of lavender or bergamot essential oils on a tissue, and the staff keep it in their pocket throughout their shift. When they need to, they breathe in the scent from the tissue. The anxiety-reducing effects are noticeable.

More Stress-Relief at WorkEileen emphasizes the importance of finding ways to

soothe and de-stress during the workday — no matter how busy you may be.

“Self-care is so important,” said Eileen. “Taking the time for yourself can really impact the patients and the care they receive. Look for different ways to do that, there are many.”

Eileen recommends the following:• Turn on soft, healing music in your nursing unit as

a form of sound therapy.• Find a certified acupuncturist; even using it once

a month can be helpful.• Use lavender during your shift. Put a few drops

on a tissue, carry it with you, and breathe it in once in a while.

• Deep breathing is a quick, simple way to lower your heart rate and anxiety levels.

How do you lower your stress levels while working? Share your tips with us on Facebook.

HEALTHY NEW MEXICO

http://unmhjobs.com


‘The Liz Thomson Award for Leadership and Advocacy’ is named after State of New Mexico’s House of Representatives, Rep. Liz Thomson. One graduate of New Mexico Partners in Policymaking is selected annually by a committee comprised of professionals, family members and self-advocates to determine who exemplifies leadership and advocacy through their significant contributions to the disability community in New Mexico. In a ceremony in Albuquerque on January 17, 2020, Siri GuruNam Kaur Khalsa, a 1996 Partners graduate, was recognized for her extraordinary accomplishments.

She was nominated by Ms. Nat Dean, a Disability Advocate and former recipient of the award, who stated, “How Siri GuruNam Kaur Khalsa applies her extensive education in nursing and health policy in her professional career as a nurse and nursing educator exhibits deep engagement not only in community service but also in community and the love of family and can be described as nothing but remarkable. She transcends boundaries - be they societal barriers or concrete blockades - while her every move remains infused with grace, dignity and thoughtful reflection.”

Siri GuruNam Kaur lives with her husband and two adult sons in Northern New Mexico. One of her sons has developmental disabilities (DD) from birth; including autism, cortical vision impairment and seizures. She works full time as a Nursing Faculty, is working on her Nursing PhD in Health Policy at the College of Nursing at the University of New Mexico, serves as a leader in the Sikh Community and cares for her adult son with DD.

Her PhD thesis, ‘The Lived Experiences of Parenting Adults with Developmental Disabilities/Intellectual Disabilities’ looks at how meaningful the resources of families are for adults with disabilities and has already been recognized as such important research that the New Mexico Department of Health Developmental Disabilities Support Division (DDSD) has opened the door that will allow distribution of flyers leading to wider data collection from affected families in New Mexico. It is widely believed that her research will become invaluable to New Mexico as the state moves forward to address specialized needs of its DD population.

Some parts of her advocacy story grew out of pursing an equal education for her son. Among these efforts, she formed a network with other mothers in the Española School District, creating a powerful group that began to address several district-wide problems regarding appropriate access to school-based inclusion of their children with disabilities. This was instrumental in bringing forward a number of concerns, receiving local newspaper coverage. She also networked with Kathy McGunn, a Special Education Autism Specialist in the Santa Fe School District, leading to the formation

Nurse Educator/Advocate Receives 2020 Disability-Focused Leadership & Advocacy Award from University of New Mexico’s

‘Partners in Policymaking’ Programof a Parent Support Group in the Santa Fe/Rio Arriba School Districts. Between 1996-98, she served as the UNM-based Center for Development and Disability (CDD) Parent Liaison for the Santa Fe County under Judy Liddell.

Siri GuruNam Kaur makes numerous trips to the New Mexico State Legislature throughout the year to testify in support of many disability and health policy concerns. She attends various meetings of the New Mexico Department of Health Advisory Council on Quality and in November 2016, she addressed the Council regarding the practice of some health insurance Managed Care Organizations (MCOs) placing many Medicaid-qualified adults on Family Planning Medicaid instead of regular Medicaid. In her testimony, she brought forward how individuals at 65-plus years of age who were dependent on Medicaid to cover their Medicare co-pays of 20% or more, could end up caught unawares with enormous co-pays in the event of a hospitalization.

As a University of New Mexico LEND (Leadership Education in Neurodevelopmental and related Disabilities) fellow in 2012-2013 and 2014-2015 she participated in a student-run pilot study using ‘Family Match Reflection’ papers written by LEND fellows about their observations and interactions during pre-arranged family match assignments. She wrote up the formal IRB (Office of Institutional Review Board, which protects persons in human research) to identify:

• the types of experiences had by the families as identified by the student,

• the experiences of the LEND students, • and the role of the LEND program in the

development of future leaders in the many areas of disability practice.

At present, the research study is partially completed, with ongoing engagement of fellow PhD and LENDS fellow, Beret Ravenscroft along with UNM faculty advisor, Dr. Judy Liesveld.

She is a nursing instructor at New Mexico Highlands University, teaching RNs who are tracking their RN to BSN degree. In her classes she brings in social justice issues to heighten student awareness and deepen their awareness of disability concerns. She has served on boards or committees for:

• The Arc of New Mexico; • The Community Advisory Committee for the

UNM Centers for Development and Disability (CDD);

• The New Mexico Nurses Association;• The Rio Arriba Health Council;• Hacienda de Guru Ram Dass (HGRD) Vice-Chair

of the Community Board;• Hacienda de Guru Ram Dass (HGRD) Financial

Boards;• and others.

Ana Moran, the coordinator of the Northern New Mexico Outreach Council, has reached out to include Siri GuruNam Kaur’s input about the impact of the Affordable Care Act, Medicaid, Medicare and Social Security on the citizens of New Mexico.

Siri GuruNam Kaur has a growing footprint in current and developing diverse areas of leadership and advocacy. When her PhD dissertation is published, it will be a resource like none other, enlarging the knowledge base of professionals both in- and outside of New Mexico. As she continues to teach, perform outreach and give testimony in a multiplicity of settings, the entities that deliver services and supports to community and the policymakers who rely on advocates like her to guide them - not to mention those she teaches both in the classroom and by example - will be enriched beyond measure.

At the awards ceremony, Ms. Dean re-stated her belief in the awardee by saying, “We do well as a society when we provide recognition to those who serve as Siri GuruNam Kaur Khalsa has and does. Providing such recognition to calm, steady leaders such as she, we make great leaders more visible to a public which, in these times have a desperate need for exposure to more positive role models who bring forward truth, tolerance and love.”

Nurses in the News

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Donna Dowell, CFNP

Every year, employers change plans and benefits because of rising healthcare costs. Private insurance companies routinely increase the premiums, deductibles, copays, and co-insurance for their plans. Unions, at every contract negotiation, have to fight for insurance and often give up other benefits in order to keep their health plans.

Patient “cost-sharing” (the portion of costs that patients pay) is increasingly prohibitive and restricts their access to “benefits” (the medical services covered by their insurance plans). Increased cost-sharing—and out-of-network “surprise bills”—can result in crushing financial debt for individuals and families. The insured face frustration, life-threatening delays, denials, and maddening bureaucracy when they actually try to use the insurance they pay so dearly for. While employees may appreciate the healthcare coverage, they do not love the insurer.

Health professionals who care about their patients and want to provide well-established, standard treatments and medications spend hours each day challenging insurance denials on their patients’ behalf. As a family nurse practitioner, I have experienced these frustrating interactions over and over again. Every insurance company, with its multiple plans, has its own set of byzantine procedures, rules, PAs, and forms to navigate—all with the goal of reducing costs by reducing

A Healthcare System in Crisis — and New Mexico’s Homegrown Solution

utilization. The negative short- and long-term impacts of this system on the health outcomes of patients are legion.

The current system is inhumane and unsustainable. It needs to change. And since there appear to be no solutions coming anytime soon from Washington DC, working at the state level is our best chance for reform.

NM Health Security ActThe New Mexico Health Security Act (2021) ensures quality, affordable healthcare

for all New Mexicans. This legislation, which will be introduced next January in the state legislature, enables New Mexico to set up its own health plan with freedom of choice of providers, no networks, and a comprehensive benefits package that is equal to or greater than what state employees currently receive. Without networks, any patient can see any provider. Eligibility for the Health Security Plan is based on state residency, and coverage is provided without regard to gender, age, preexisting condition, or employment status.

Can New Mexico Afford a Universal Health Plan?A fiscal analysis of the Health Security Plan, overseen by the NM Legislative

Finance Committee, is currently underway. The goal of this study is to determine the cost of the plan and whether revenue from various sources—public dollars (like Medicaid and Medicare), income-adjusted premiums, employer contributions, and federal subsidies—are sufficient to pay for the plan. If so, the plan should be economically viable. (Two earlier New Mexico studies found that the Health Security approach would cost millions of dollars less each year than the current system.)

Savings will come from efficiencies in the plan’s design that lower administrative costs. A comprehensive, uniform benefits package that clearly states what is covered, and uniform billing procedures for all the New Mexicans covered under this plan are two such sources of administrative savings.

Savings will also come from negotiating discounts. With a large pool of approximately 1.7 million New Mexicans expected to be enrolled, the plan can negotiate for lower drug, medical equipment, and medical device pricing.

Is This a Single Payer System? (No)The Health Security Plan is not a single payer system. Federal employees and

active-duty and retired military personnel are exempt from the plan and would keep their existing coverage. Tribes, as sovereign nations, could opt in. ERISA-compliant employers may also opt in. Everyone else would be automatically covered by the Health Security Plan. This approach ensures that everyone in the state has coverage.

The role of private insurance is shifted under the Health Security Plan. Private insurance companies may offer supplemental policies to Health Security Plan members as long as coverage does not duplicate the comprehensive services offered by the Health Security Plan.

Who Will Pay for It? (No New Taxes)The Health Security Plan is not a taxed-based system. Instead, it combines

individual premiums, employer contributions, and public money spent on healthcare. Employer contributions will be based on payroll and number of employees, with caps. Individual premiums will be based on a sliding scale by income, also capped. Only members of the Health Security Plan will pay into the plan.

A Healthcare System in Crisis...continued on page 15

To access electronic copies of the New Mexico Nurse, please visit

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http://www.denvercollegeofnursing.edu

http://www.hlccommission.org

http://www.denvercollegeofnursing.edu


Larider Ruffin, DNP, APN, NP-C, ANP-BC, A-GNP, CRNP, CTTS, Assistant Professor of Nursing at Stockton University

Maria Caccavo, BSN, RN, Graduate Nursing Student at Stockton University

Reprinted with permission from New Jersey Nurse, January 2020

Electronic cigarettes (E-cigarettes) are battery-operated devices that transport a nicotine-containing aerosol or vapor by heating the liquid. The liquid usually contains nicotine, propylene glycol or glycerol, chemicals, and a flavoring agent. In addition, e-cigarettes are used to vape illicit substances such as cannabis. When the chemicals are heated, they convert to toxic aldehydes that cause lung disorders, inflammation, and upper airway irritation. Some of the flavorings for e-cigarettes contain chemicals that can cause inflammatory obstruction of the bronchioles. This is called bronchiolitis obliterans (popcorn lungs).

Bronchiolitis obliterans is an injury to the small airways. The signs and symptoms of bronchiolitis obliterans are cough, dyspnea, wheezing, and fatigue. The symptoms are usually slow and progressive (Duderstadt, 2015; Gonzalvo, Constantine, Shrock, & Vincent, 2016; Schnur, 2019).

E-cigarette use increased in high school students in the United States (U.S) from 11.7% in 2017 to 20.8% in 2018. E-cigarette use increased in middle school

The Nurses’ Role in the Vaping Crisisstudents in the U.S from 3.3% in 2017 to 4.9% in 2018. Approximately 3.62 million middle and high school students were current users of e-cigarettes in 2018 (FDA, 2019). Current advertising and health debates about e-cigarette use do not include the negative health effects of nicotine addiction and the vulnerability of young people to nicotine because their brains are in a critical time of development (Duderstadt, 2015).

If a patient has been vaping and has respiratory issues such as a cough, shortness of breath, wheezing, or chest pain, they should go to the Emergency Department (ED) immediately. Patients that vape should tell their primary care provider (PCP) of any of the symptoms immediately for further direction. The role of nurses during the vaping crisis is to be knowledgeable about vaping, advocate for patients, follow institutional protocol, and if popcorn lung is suspected in the community, patients should be referred to the ED for prompt evaluation. As the most trusted professionals, nurses should support patients to stop smoking and vaping (Schnur, 2019).

Nurses should know that the nicotine in e-cigarettes varies from zero to 36 mg/mL. Even the so-called nicotine-free products have been shown to contain nicotine, and heating e-liquid which elevates temperatures increases nicotine release and its negative effects. When nurses are evaluating patients with respiratory issues, they should ask patients if they have used e-cigarette products or vaped in the last three months. If the patients say yes, nurses should ask about the substances used (homemade liquid, re-used old cartridges, commercially purchased liquids, etc.), the brand name, purchased location, whether e-cigarettes were shared with others. The nurse should act accordingly and report to the Department of Health (Schnur, 2019).

The popularity of young people vaping is growing. Young people are vulnerable to social and environmental pressures to use tobacco products. Legislation to prevent the sales, marketing, and use of e-cigarettes can help protect susceptible children from negative long-term health effects (Duderstadt, 2015).

ReferencesDuderstadt, K. (2015). E-Cigarettes: Youth and Trends in Vaping. Journal of Pediatric

Health Care, 29(6), 555–557. https://doi.org/10.1016/j.pedhc.2015.07.008Gonzalvo, J., Constantine, B., Shrock, N., & Vincent, A. (2016). Electronic Nicotine

Delivery Systems and a Suggested Approach to Vaping Cessation. AADE in Practice, 4(6), 38–42. https://doi.org/10.1177/2325160316666115

Schnur, M. (2019). Vaping Epidemic: A Public Health Crisis. Retrieved from https://www.nursingcenter.com/ncblog/september-2019/vaping-epidemic

U.S. Food & Drug Administration. (2019). Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS). Retrieved from https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends

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Reprinted with permission from Nevada RNformation February 2020 issue

Horizontal violence, lateral violence, vertical violence, and bullying are names used interchangeably. However, lateral and horizontal violence are peer to peer disruption and vertical violence and bullying are inferred to be from the top-down. However, the behavior is dissected, it’s disruptive, uncivil, unprofessional, and unhealthy, especially in healthcare.

Bullying behaviors may be blatant or subtle and intentional or unintentional, including verbal innuendos (snide remarks), insults, gossiping, backstabbing, backbiting, exclusion, intimidation, omitting information, and negative non-verbal actions (eye-rolling, arm-crossing).

People in leadership roles may misuse their authority by not only demonstrating the behaviors above, but also by removing or adding roles, responsibilities, and assignments without justification, giving ultimatums and threats, and accommodating, growing, and building some staff but not others for personal, rather than professional reasons.

Mikaelian & Stanley (2016) identified 98% of nurses surveyed reported experiencing some form of incivility. According to Sauer and McCoy (2019), workplace bullying in nursing is a persistent problem, with 40% of the 309 nurses surveyed reported being bullied within the past six months (p. 223). Also noted, 68% of the nurses surveyed witnessed a co-worker being bullied.

The frequency of experiencing bullying, affects nurses’ physical and psychological health complaints

Horizontal or Vertical Violence: It’s All Disruptiveand leads to depressive symptoms (Dehue, Bolman, Vollink, Pouweise, 2012). These behaviors may also affect productivity, sleep, anxiety, quality care, patient safety, employee, patient, and physician satisfaction, healthcare costs, turnover, burnout, and absences (Giorgi, et al., 2016; Shimp, 2017; Wright, Khatri, 2015).

Davidson, Proudfoot, Lee, and Zisook (2019) completed a longitudinal analysis of nurse suicide rate in the United States and recently published their findings. Firth (2019), from MedPage Today, asserts that Davidson stated, “…nurses are at higher risk of suicide than the general population.” Although Davidson, et al. (2019) did not discuss or infer a relationship between bullying and suicide, the possibility is valid. Feelings of anxiety, depression, not wanting to go to work, turning inward and feeling hopeless are all feelings, if left untreated, may lead to attempting and committing suicide.

Bullying is an activity that disrupts the health care environment which may negatively impact patient safety and outcomes, according to The Joint Commission (2015). Institutions are responsible for maintaining a healthy work environment and policies were created to hold perpetrators accountable. The American Nurses Association Code of Ethics for Nurses (American Nurses Association [ANA], 2019) guides our nursing practice. It reminds nurses to be respectful and compassionate to everyone, to treat others with dignity and value, to participate in creating “environments and conditions of employment conducive to the provision of quality health care,” to collaborate with other members of the healthcare team, and to maintain the integrity of the nursing profession.

An Incivility in the Workplace Nursing Survey, after IRB approval, will be available through the Nevada Nurses Association and Nevada Nurses Foundation website. Please complete the survey and share it with your nursing colleagues to find out where we stand

after over 20 years of identifying nurse to nurse bullying. Let’s be the change we all wish to see in nursing and support one another, model the behaviors we wish to see, and “do unto others as we would have them do unto us.”

For more information, please email me at [email protected].

ReferencesAmerican Nurses Association (2019). Code of Ethics for

Nurses. Retrieved from http://www.nursingworld.org Davidson, J. E., Proudfoot, J., Lee, K., Zisook, S. (2019).

Nurse suicide in the United States: Analysis of the center for disease control 2014 national violent death reporting system dataset. Archives of Psychiatric Nursing 33(5), 16-21.

Dehue, F., Bolman, C., Vollink, T., Pouweise, M. (2012). Coping with bullying at work and health related problems. International Journal of Stress Management, 19(3), 175-197. https://www.sciencedirect.com/science/article/abs/pii/S0883941719300287

Giorgi, G., Mancuso, S., Perez, F.F., D’Antonio, A.C., Mucci, N., Cupelli,V., & Arcangeli, G. (2016). Bullying among nurses and its relationship with burnout and organizational climate. International Journal of Nursing Practice, 22(2), 160-168. doi:10.1111/ijn.12376

Mikaelian, B., & Stanley, D. (2016, May 31). Incivility in nursing: from roots to repair. Journal of Nursing Management. Retrieved from Pubmed.

Sauer, P. A., McCoy, T. P. (2018). Nurse bullying and intent to leave. Nursing Economic$, 36(5), 219-224, 245.

Shimp, K. M. (2017). Systematic review of turnover/retention and staff perception of staffing and resource adequacy related to staffing. Nursing Economic$, 35(5), 239-266.

The Joint Commission (2015). Sentinel event statistics released for 2014. Retrieved from http://www.jointcommission.org/assets/1/23/jconline_April_29_15.pdf

Wright, W. & Khatri, N. (2015). Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Management Review, 50(2), 139-147.

Nurse Practitioner (CNP) – Contract Based

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ANA/New MexicoMembership ApplicationFor other information, please contact ANA's Membership Billing Department at (800) 923-7709 or email us at [email protected].

Essential Information:

City/State/Zip Email Address

Employer Current Employment Status: (e.g. full-time, part-time, per diem, retired)

Type of Work Setting: (e.g. hospital, clinic, school) Current Position Title: (e.g. staff nurse, manager, educator, APRN)

Practice Area: (e.g. pediatrics, education, administration) RN License # State

FaxCompleted application with credit cardpayment to (301) 628-5355

WebJoin instantly onlineVisit us at www.JoinANA.org

MailANA Customer & Member BillingP.O. Box 504345 St. Louis, MO 63150-4345

First Name/MI/Last Name

Mailing Address Line 1

Mailing Address Line 2

Professional Information:

Home Phone

Credentials

Date of Birth Gender: Male/Female

If paying by credit card, would youlike us to auto bill you annually?

Please Note — American Nurses Association (ANA) member ship dues are not deductible as charitablecontributions for tax purposes, but may be deductible as a business expense. However, the percentageof dues used for lobbying by the ANA is not deductible as a business expense and changes each year.Please check with ANA for the correct amount.

Dues ..........................................................................................$

ANA-PAC Contribution (optional) ..................................$

American Nurses Foundation Contribution ...............$(optional)

Total Dues and Contributions ..........................................$

Authorization Signatures:

Monthly Electronic Deduction | Payment Authorization Signature*

Automatic Annual Credit Card | Payment Authorization Signature*

*By signing the Monthly Electronic Payment Deduction Authorization, or the Automatic AnnualCredit Card Payment Authorization, you are authorizing ANA to change the amount by giving theabove signed thirty (30) days advance written notice. Above signed may cancel this authorizationupon receipt by ANA of written notification of termination twenty (20) days prior to deduction datedesignated above. Membership will continue unless this notification is received. ANA will charge a $5fee for any returned drafts. ANA & State and ANA-Only members must have been a member for sixconsecutive months or pay the full annual dues to be eligible for the ANCC certification discounts.

Credit Card Information:

Credit Card Number

Authorization Signature

Printed Name

Expiration Date (MM/YY)

Membership Dues:

Annual Payment

Ways to Pay:

CheckCredit Card

Checking Account Attach check for first month’s payment. Please make checks payable to ANA.

Credit Card

Monthly Payment

Visa Mastercard

Yes

How did you hear about ANA? Colleague Magazine Online Other: __________________________

Go to www.JoinANA.org to become a member and use the code: NMX14

Mail

Mobile Phone

*Nurses must already hold an RN license before becoming members of ANA

Joint Membership $238.00 $20.34Yearly Monthly

Who Will Run It? (Not State Government)The Health Security Plan is not government-run.

Like a co-op, the plan will be run by a geographically representative commission, with ten commissioners representing consumer and employer interests and five representing provider and health facility interests. The commission will be subject to transparency rules and the Open Meetings Act and will be informed by advisory councils and residents from all parts of the state, rural and urban.

How Will the Health Security Plan Help Nurses?The Health Security Plan will have a positive impact

on nurses—and their patients. Patients will enjoy better health outcomes due to comprehensive coverage and removal of barriers to access. Nurses will be able to spend more time with patients and less on the phone with insurance companies. In addition, the Health Security Act provides for investments in rural and urban healthcare infrastructure, as identified and prioritized by individual communities.

A nursing scope of practice traditionally encompasses care that has been undervalued and poorly incentivized by reimbursements. Care coordination, case management, disease prevention, health promotion, patient education and empowerment, local public health, and mental health issues are all areas where nurses work tirelessly, often without sufficient resources, to improve health outcomes. The potential for bold change in these arenas is real under the Health Security Act.

Donna Dowell FNP, is a guest contributor and participant of the Health Security for New Mexicans Campaign. Visit www.nmhealthsecurity.org for further information and to become familiar with the Health Security Plan and how it helps providers, patients, seniors, small businesses, etc.

The Campaign is a broad grassroots coalition of organizations and individuals across New Mexico that support the Health Security Act. Approximately 175 New Mexico organizations—including NMNA—are members of the Campaign, and 35 counties and municipalities have endorsed the Health Security Act.

A Healthcare System in Crisis...continued from page 12

RN POSITIONS OPEN in Silver City, New Mexico

OFFERING: Competitive pay, holiday pay, shift differential and holiday differential pay, day and night shifts, excellent benefit package, including health, dental, vision, disability and life insurance, 401k match, generous PTO.

Visit hmsnm.org or call 575-534-0788for more information.

BEING WITH DYING: for clinicians in the compassionate care of the seriously ill and dying

cnes for nurses • scholarships available

Develop knowledge and skills in the psycho-social, ethical, existential, and spiritual aspects of illness and dying. This program includes an introduction

to G.R.A.C.E.®, cultivating compassion while interacting with others.

Faculty, above: Roshi Joan Halifax, PhD, center. From left: Anthony Back, MD; Kathleen Turner; Holly Yang, MD; Jan Jahner, CHPN; Sensei Al Kaszniak, PhD; Cynda Hylton Rushton, PhD, RN, FAAN; Rev. Corinna Chung; Mary Taylor; Donna Kwilosz, PhD.

MORE INFO AT UPAYA.ORG/PROGRAMS • SANTA FE, NM • 505.986.8518 EXT: 112

UPAYAINSTITUTE ZEN CENTERand

professional training programapril 30 - may 7, 2021

FOR CNE INFORMATION CONTACT: [email protected]

http://go.unm.edu/nursing

http://upaya.org/programs

mailto:registrar%40upaya.org?subject=

http://bit.ly/GenesisNMJobs

http://www.genesiscareers.jobs

http://centura.org/careers

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